Employee Critical Illness Option

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1 ECIO Employee Critical Illness Option Financial Protection for the Unexpected Includes Cancer Benefit First Occurrence Additional Occurrence Reoccurrence Spouse Coverage Available Child Coverage at No Additional Cost Includes Health Screening Benefit Underwritten by: BOSTON MUTUAL LIFE INSURANCE COMPANY UNIVERSITY OF GEORGIA UGA 3/09

2 THE FACTS ACCORDING TO MEDICAL STATISTICS: FEATURES: About 1,444,290 new cancer cases are expected to be diagnosed in The National Institutes of Health estimate the overall costs for cancer in the year 2006 at $206.3 billion: $78.2 billion for direct medical costs and $128.1 billion for indirect costs. 1 An estimated 700,000 Americans will have a new coronary attack in 2007 and about 500,000 will have a recurrent attack. 2 It is estimated that a stroke will occur every 45 seconds in The estimated direct and indirect cost of cardiovascular disease is $431.8 billion in Cancer Facts & Figures - American Cancer Society Heart and Stroke Statistical Update - American Health Association Lump-sum benefits paid directly to the insured following the diagnosis of each covered specified critical illness. Re-occurrence and additional occurrence also covered. Spouse coverage available up to $25,000 benefit amount. Each dependent child is covered at 10 percent of the primary insured amount at no additional charge. Rates cannot be individually increased due to change in age, health or individual claim. Annual health screening benefits included. Simplified underwriting answer only a few health questions. The plan is portable* take your coverage with you if you leave your job. * Certain stipulations apply to portability ELIGIBILITY INDIVIDUAL ELIGIBILITY All active benefit eligible employees, between the ages of working at least 20 hours or more weekly, are eligible. If an employee is eligible, their spouse ages 18-69, are eligible for coverage and all children of the insured who are unmarried and less than twenty-five (25) years of age. SPOUSE COVERAGE AVAILABLE The employee may elect to purchase spouse coverage. In order to apply for spouse coverage, the employee must also apply. The spouse amount may not exceed 50% of the employee amount, subject to the minimum face amount of $5,000. If the employee does not meet the underwriting requirements necessary to participate in the plan, the spouse can still obtain coverage. DEPENDENT CHILDREN COVERAGE AT NO ADDITIONAL CHARGE Each eligible dependent child is covered at 10 percent of the primary insured amount at no additional charge. EFFECTIVE DATE OF COVERAGE Coverage is effective on the date the application is signed, provided that the employee is actively at work. This policy also contains a 30-day waiting period. This means that no benefits are payable for any insured before coverage has been inforced for 30 days after the application has been signed. (refer to limitation on page 6) PORTABILITY Coverage may continue after leaving employment at the same premium. The employee must have been continuously insured for at least six months prior to terminating employment. The employee can continue the coverage that is inforce on the date employment ends, including dependent coverage. 2

3 PLAN BENEFITS FIRST OCCURRENCE BENEFIT Lump Sum Benefits payable upon initial diagnosis of a covered illness or condition. Employee benefit amounts available from $5,000 to $50,000. Spouses may purchase up to 1/2 of employee benefit amount. ADDITIONAL OCCURRENCE BENEFIT If an insured collects full benefits for a Critical Illness under the plan and later has one of the remaining covered illnesses/procedures, then we will pay the full benefit amount for each additional illness. Occurrences must be separated by at least 6 months. RE-OCCURRENCE BENEFIT If an insured collects full benefits for a covered condition and is later diagnosed with the same condition, we will pay the full benefit again. The two dates of diagnosis must be separated by at least 12 months or 12 months treatment free for cancer. Covered Critical Illnesses Cancer 100% Carcinoma in SITU 25% Heart Attack (Myocardial Infarction) 100% Coronary Artery Bypass Surgery 25% Stroke (Apoplexy or Cerebral Vascular Accident) 100% Major Organ Transplant 100% Renal Failure (End Stage) 100% All covered conditions are subject to the definitions found in the employee s certificate. NOTE: If a benefit is paid for carcinoma in situ, the internal cancer benefit will be reduced by 25%. If a benefit is paid for coronary artery bypass surgery, the heart attack benefit will be reduced by 25%. $50 HEALTH SCREENING BENEFIT (employee and spouse only) After the Waiting Period, an insured may receive a maximum of $50 for any one covered health screening test per calendar year. We will pay this benefit regardless of the results of the test. There is no limit to the number of years the insured can receive the health screening benefit; it will be paid as long as the certificate remains inforce. This benefit is not paid for dependent children. Covered Health Screening Tests Include: Mammography Colonoscopy Pap smear Breast ultrasound Chest x-ray PSA (blood test for prostate cancer) Stress test on a bicycle or treadmill Bone marrow testing CEA (blood test for colon cancer) Flexible sigmoidoscopy Hemocult stool analysis Serum protein electrophoresis (blood test for myeloma) Thermography Fasting blood glucose test, blood test for triglycerides or serum cholesterol test to determine level of HDL and LDL CA 15-3 (blood test for breast cancer) CA 125 (blood test for ovarian cancer) 3

4 MONTHLY RATES EMPLOYEE Ages $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $3.99 $6.19 $8.39 $10.59 $12.79 $14.99 $17.19 $19.39 $21.59 $ $5.89 $9.99 $14.09 $18.19 $22.29 $26.39 $30.49 $34.59 $38.69 $ $10.79 $19.79 $28.79 $37.79 $46.79 $55.79 $64.79 $73.79 $82.79 $ $17.69 $33.59 $49.49 $65.39 $81.29 $97.19 $ $ $ $ $27.29 $52.79 $78.29 $ $ $ $ $ $ $ MONTHLY RATES SPOUSE Ages $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $3.99 $5.09 $6.16 $7.29 $8.39 $9.49 $10.59 $11.69 $ $5.89 $7.94 $9.99 $12.04 $14.09 $16.14 $18.19 $20.24 $ $10.79 $15.29 $19.79 $24.29 $28.79 $33.29 $37.79 $42.29 $ $17.69 $25.64 $33.59 $41.54 $49.49 $57.44 $65.39 $73.34 $ $27.29 $40.04 $52.79 $65.54 $78.29 $91.04 $ $ $ Rates include benefits for the Cancer, Additional Occurrence, Re-occurrence and Health Screening. 4

5 DEFINITIONS DEFINITIONS Treatment Means consultation, care or services provided by a physician including diagnostic measures and taking prescribed drugs and medicines. Major Organ Transplant Means undergoing surgery as a recipient of a transplant of a human heart, lung, liver, kidney, or pancreas. Myocardial Infarction (Heart Attack) Means the death of a portion of the heart muscle (myocardium) resulting from a blockage of one or more coronary arteries. Heart attack does not include any other disease or injury involving the cardiovascular system. Cardiac Arrest not caused by a myocardial infarction is not a heart attack. The diagnosis must include all of the following criteria: 1. New and serial Electrocardiographic (EKG) finding consistent with Myocardial Infarction; and 2. Elevation of cardiac enzymes above generally accepted laboratory levels of normal [in case of creatine physphokinase (CPK), a CPK-MB measurement must be used]. 3. Confirmatory imaging studies such as thallium scans, MUGA scans, or stress ecocardiograms. 4. Chest Pain. Stroke Means Apoplexy (due to rupture or acute occlusion of a cerebral artery), or a cerebral vascular accident or incident, which is first manifested on or after the policy date, Stroke does not include Transient Ischemia Attacks and attacks of Verterbrobasilar Ischemia. We will pay a benefit for Stroke which produces permanent clinical neurological sequela persisting for at least 30 days following an initial diagnosis made after any applicable Waiting Period. We must receive evidence of the permanent neurological damage provided from Computed Axial Tomography (CAT scan) or Magnetic Resonance Imaging (MRI). Stroke does not mean head injury, transient Ischemia attack or chronic cerebrovascular insufficiency. Cancer Means a malignant tumor characterized by the uncontrolled growth and spread of malignant cells and the invasion of distant tissue. Cancer includes leukemia. Excluded are Cancers such as 1. Pre-malignant tumors or polyps; 2. Carcinoma in Situ (non-invasion); 3. Any skin cancers except melanomas; 4. Stage 1 Hodgkin s Disease; 5. Stage A Prostate Cancer; 6. Melanoma that is diagnosed as Clark s Level I and II or Breslow less than.77 mm; 7. Basal cell carcinoma and squamous cell carcinoma of the skin. Carcinoma in situ Means Cancer that is in the natural or normal place, confined to the site without having invaded neighboring tissue. Cancer and/or carcinoma in situ must be diagnosed in one of two ways: 1. Pathological Diagnosis A pathological diagnosis of cancer or carcinoma in situ is based on a microscopic study of fixed tissue or preparations from the hemic (blood) system. This type of diagnosis must be done by a certified pathologist whose diagnosis of malignancy is in keeping with the standards set by the American Board of Pathology. 2. Clinical Diagnosis A clinical diagnosis of cancer or carcinoma in situ is based on the study of symptoms. We will pay benefits for a clinical diagnosis only if: a. A pathological diagnosis cannot be made because it is medically inappropriate or life threatening; b. There is medical evidence to support the diagnosis; and c. A doctor is treating the insured for cancer and/or carcinoma in situ. Renal Failure (Kidney Failure) Means the end stage renal failure presenting as a chronic, irreversible failure of both of your kidneys to function. The Kidney failure must necessitate regular renal dialysis, hemo-dialysis or peritoneal dialysis (at least weekly); or which results in kidney transplantation. Renal failure is covered, provided it is not caused by a traumatic event, including surgical traumas. Coronary Artery Bypass Surgery Means undergoing open heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass grafts, but excluding procedures such as, but not limited to balloon angioplasty, laser relief, stints or other non-surgical procedures. 5

6 LIMITATIONS & EXCLUSIONS LIMITATIONS / EXCLUSIONS If a diagnosis occurs after the age of 70, half of the benefit is payable. This Certificate contains a 30-day Waiting Period. This means no benefits are payable for any Insured who has been diagnosed before coverage has been in force 30 days from the Effective Date shown in the Certificate Schedule. If an Insured is first diagnosed during the Waiting Period, benefits for treatment of that Critical Illness or Specified Procedure will apply only to loss commencing after 12 months from the Effective Date of their coverage; or, at your option, you may elect to void the Certificate from the beginning and receive a full refund of premium. The applicable benefit amount will be paid if: the date of diagnosis is after the waiting period; the date of diagnosis occurs while the certificate is in force; and the cause of the illness is not excluded by name or specific description. Benefits will not be paid for loss due to: 1. Intentionally self-inflicted injury or action; 2. Suicide or attempted suicide while sane or insane; 3. Illegal activities or participation in an illegal occupation; 4. War, whether declared or undeclared or military conflicts; participation in an insurrection or riot, civil commotion or state of belligerence. 5. Substance abuse; or 6. Pre-existing conditions (except as stated below). PRE-EXISTING CONDITION LIMITATION Pre-existing Condition means a sickness or physical condition which, within the 12-month period prior to the effective date of the certificate, either: 1. Resulted in an insured person s receiving medical advice or treatment; or 2. Caused symptoms for which an ordinarily prudent person would seek medical advice or treatment. We will not pay benefits for any condition or illness starting within 12 months of the effective date which is caused by, contributed to, or resulting from a pre-existing condition. A claim for benefits for loss starting after 12 months from the effective date will not be reduced or denied on the grounds that it is caused by a pre-existing condition. A condition will no longer be considered pre-existing at the end of 12 consecutive months starting and ending after the effective date. Underwritten by: FOR CLAIMS AND CUSTOMER SERVICE CALL TOLL FREE: This brochure provides a general description of the important features of the policy/certificate. This brochure is not the insurance contract and only the actual policy/certificate provisions will control. The policy may not be available in all states and state variations may apply. See certificate for detail regarding exclusions. Exclusions may vary by state. 6

7 Over a Century of Service BOSTON MUTUAL LIFE INSURANCE COMPANY 120 Royall Street Canton, Massachusetts UGA 3/ Policy Series #BML MP University of Georgia

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